Chief Compliance Officer, Medicare Advantage

Communicare Health Services - Baltimore, MD

Full-time - Mid Level

Baltimore, MD

Social Assistance

About the position

The Chief Compliance Officer for CommuniCare Advantage plays a critical role in ensuring that the Medicare Advantage plan adheres to all relevant regulations and internal controls. This position involves a comprehensive examination and analysis of records, reports, operating practices, and documentation to identify areas of non-compliance and recommend improvements to strengthen the internal control structure. The Chief Compliance Officer is responsible for overseeing all internal auditing activities, ensuring that documentation is timely delivered and properly maintained, and that all auditing activities are documented with prompt and accurate follow-up. In this role, the Chief Compliance Officer will conduct and document internal audits across all business units, identifying compliance issues that require follow-up or investigation. The officer will also organize and participate in external audits, ensuring that all compliance-related documentation is in order. A key responsibility includes developing and maintaining a master compliance auditing log and a historical corrective action log to facilitate internal auditing processes. The Chief Compliance Officer will prepare for audits by researching relevant materials and formulating action plans, while also ensuring compliance with regulations by analyzing operational practices and documentation. The position requires effective communication of audit progress and findings through detailed reports and presentations in meetings. The Chief Compliance Officer will support external auditors by coordinating information requirements and providing management reports that summarize collected data. Continuous professional development is essential, as the officer will need to stay current on industry standards and legislative changes, advising management on necessary actions to ensure compliance with local, state, and federal legal requirements. This role also involves fostering strong relationships within the organization and contributing to special projects as assigned.

Responsibilities

• Conduct and document internal audits of all business units to identify and correct areas of non-compliance.
• Organize, document and participate in all external audits, identifying compliance issues that require follow-up or investigation.
• Develop, implement, and document a master compliance auditing log.
• Disseminate written policies and procedures related to compliance activities.
• Create and maintain a historical corrective action log for internal auditing.
• Meet work standards by following production, productivity, quality, and customer-service standards; resolving operational problems; identifying work process improvements.
• Prepare for audits by researching materials and formulating a plan of action.
• Ensure compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; recommending opportunities to strengthen the internal control structure.
• Complete audit work papers and memorandums by documenting audit tests and findings.
• Communicate audit progress and findings by preparing reports and providing information in meetings.
• Support external auditors by coordinating information requirements.
• Provide management reports by collecting, analyzing, and summarizing management information.
• Update job knowledge by participating in educational opportunities and maintaining personal networks.
• Enhance compliance department and organization reputation by accepting ownership for accomplishing new and different requests.
• Answer questions regarding regulations.
• Study both existing and new legislation, enforce policies and advise management on necessary actions to ensure compliance with legal requirements.
• Stay current on industry standards.
• Support special projects and other tasks as assigned.

Requirements

• Bachelor's degree in healthcare or equivalent work experience.
• Minimum three years in managed health care.
• Minimum two years in health care compliance.
• Strong knowledge of industry standards and guidelines.
• Outstanding written and verbal communication abilities.
• Familiarity with computer and necessary software.
• Detail-oriented and well-organized.
• Strong decision-making and problem-solving skills.
• Ability to foster strong relationships.
• Research and reporting skills.
• Strong statistical analysis skills.
• Managed Care Experience preferred.

Benefits

• Competitive wages and PTO plans.
• Menu of benefit options including life and disability plans, medical, dental, and vision coverage.
• 401(k) with employer match.
• Flexible Spending Accounts.